Methotrexate oral solution

What is this medicine?

METHOTREXATE (METH oh TREX ate) is a chemotherapy drug used to treat cancer including leukemia. This medicine can also be used to treat certain kinds of arthritis.

How should I use this medicine?

Take this medicine by mouth. Follow the directions on the prescription label. Use a specially marked spoon or container to measure each dose. Ask your pharmacist if you do not have one. Household spoons are not accurate. Take your medicine at regular intervals. Do not take it more often than directed. Do not stop taking except on your doctor's advice.

Make sure you know why you are taking this medicine and how often you should take it. It should be taken weekly, NOT daily. Taking this medicine more often than directed can cause serious side effects, even death.

Talk to your healthcare provider about safe handling and disposal of this medicine. You may need to take special precautions.

Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for selected conditions, precautions do apply.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

• allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

• breathing problems or shortness of breath

• diarrhea

• dry, nonproductive cough

• low blood counts - this medicine may decrease the number of white blood cells, red blood cells and platelets. You may be at increased risk for infections and bleeding

• mouth sores

• signs of infection - fever or chills, cough, sore throat, pain or difficulty passing urine

• signs of decreased platelets or bleeding - bruising, pinpoint red spots on the skin, black, tarry stools, blood in the urine

• signs of decreased red blood cells - unusually weak or tired, feeling faint or lightheaded, falls

• signs and symptoms of kidney injury like trouble passing urine or change in the amount of urine

• signs and symptoms of liver injury like dark yellow or brown urine; general ill feeling or flu-like symptoms; light-colored stools; loss of appetite; nausea; right upper belly pain; unusually weak or tired; yellowing of the eyes or skin

• vomiting

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

• dizziness

• hair loss

• nausea

• stomach pain

• tiredness

What may interact with this medicine?

Do not take this medicine with any of the following medications:

• acitretin

• aspirin and aspirin-like medicines

• live virus vaccines

• penicillamine

• probenecid

This medicine may interact with the following medications:

• azathioprine

• certain antibiotics like penicillins, trimethoprim; sulfamethoxazole, tetracycline, and chloramphenicol

• cyclosporine

• hydroxychloroquine

• NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen

• other cytotoxic agents

• phenytoin

• retinoids such as isotretinoin and tretinoin

• steroid medicines like prednisone or cortisone

• sulfasalazine

• theophylline

What if I miss a dose?

If you miss a dose, talk to your doctor or health care professional. Do not take double or extra doses.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

• fluid in the stomach area or lungs

• if you often drink alcohol

• infection or immune system problems

• kidney disease

• liver disease

• low blood counts, like low white cell, platelet, or red cell counts

• lung disease

• recent or ongoing radiation therapy

• stomach or intestine problems

• an unusual or allergic reaction to methotrexate, other medicines, foods, dyes, or preservatives

• pregnant or trying to get pregnant

• breast-feeding

What should I watch for while using this medicine?

Tell your doctor or healthcare professional if your symptoms do not start to get better or get worse.

You may need blood work done while you are taking this medicine.

This medicine can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds/booths.

Check with your doctor or health care professional if you get an attack of severe diarrhea, nausea and vomiting, or if you sweat a lot. The loss of too much body fluid can make it dangerous for you to take this medicine.

Call your doctor or health care professional for advice if you get a fever, chills or sore throat, or other symptoms of a cold or flu. Do not treat yourself. This drug decreases your body's ability to fight infections. Try to avoid being around people who are sick.

Avoid taking products that contain aspirin, acetaminophen, ibuprofen, naproxen, or ketoprofen unless instructed by your doctor. These medicines may hide a fever.

Be careful brushing and flossing your teeth or using a toothpick because you may get an infection or bleed more easily. If you have any dental work done, tell your dentist you are receiving this medicine.

This medicine may increase your risk to bruise or bleed. Call your doctor or health care professional if you notice any unusual bleeding.

This drug may make you feel generally unwell. This is not uncommon, as chemotherapy can affect healthy cells as well as cancer cells. Report any side effects. Continue your course of treatment even though you feel ill unless your doctor tells you to stop.

Talk to your doctor about your risk of cancer. You may be more at risk for certain types of cancers if you take this medicine.

Do not become pregnant while taking this medicine. Women should inform their doctor if they wish to become pregnant or think they might be pregnant. There is a potential for serious side effects to an unborn child. Men should inform their doctors if they wish to father a child. This medicine may lower sperm counts. Talk to your health care professional or pharmacist for more information. Do not breast-feed an infant while taking this medicine.